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Erythema Annulare Centrifugum

Last updated April 17, 2021

Reviewed by: Lester Fahrner, MD

Approved by: Krish Tangella MD, MBA, FCAP

Erythema Annulare Centrifugum (EAC) is an uncommon chronic condition that usually defines a pattern of skin lesion that has redness (erythema) in a ring form (annulare), which spreads from the center (centrifugum).

What are the other Names for this Condition? (Also known as/Synonyms)

  • Deep Gyrate Erythema
  • Erythema Perstans
  • Palpable Migrating Erythema

What is Erythema Annulare Centrifugum? (Definition/Background Information)

  • Erythema Annulare Centrifugum (EAC) is an uncommon chronic condition that usually defines a pattern of skin lesion that has redness (erythema) in a ring form (annulare), which spreads from the center (centrifugum)
  • Erythema Annulare Centrifugum is not a single entity by itself. It is sometimes described using the following terminologies:
    • Annular erythema
    • Darier erythema
    • Erythema figuratum perstans
    • Erythema gyratum perstans
    • Erythema gyratum repens
    • Erythema perstans
  • Erythema Annulare Centrifugum is seen in both children and adults. Numerous predisposing factors are reported that include infections, use of certain medications, chronic inflammation of the appendix, and other underlying conditions
  • In many, the exact cause of development of Erythema Annulare Centrifugum remains unknown. It is believed to be the result of stress or certain underlying infections/allergies leading to a form of skin hypersensitivity
  • Any part of the body may be affected, but many are observed on the legs. The lesions are many in number and may be itchy (pruritic). They may present cosmetic concerns in some individuals
  • A diagnosis of Erythema Annulare Centrifugum is made by studying the presenting symptoms and skin biopsy (microscopic examination of the skin lesions). Following its diagnosis, the condition may be treated using corticosteroids, if required. Also, a treatment of the underlying condition, if any present, is undertaken
  • The prognosis of Erythema Annulare Centrifugum is good in a majority of cases. It is known to resolve by its own in many individuals. However, some cases are known to persist for several months-to-years

Who gets Erythema Annulare Centrifugum? (Age and Sex Distribution)

  • Erythema Annulare Centrifugum may occur at any age; children and adults may be affected. The average age of presentation is 49 years
  • Both males and females are affected; though, a female predominance is observed
  • Individuals of all racial and ethnic background can be affected

What are the Risk Factors for Erythema Annulare Centrifugum? (Predisposing Factors)

The risk factors for Erythema Annulare Centrifugum may include a variety of factors such as:

  • Infections caused by bacteria, fungus, or virus, which include tuberculosis, candidiasis, and EBV infections
  • Inhalation allergy from molds or fungi
  • Certain food types such as cheese, tomatoes, etc. causing food allergies
  • Use of medications and hormones including antibiotics, oral contraceptive pills, antimalarial drugs, etc.
  • Skin conditions such as contact dermatitis
  • Variety of cancers including lymphomas (both Hodgkin and non-Hodgkin), leukemias, and cancers of the ovary, breast, and prostate
  • Pregnancy
  • Underlying disorders including Graves’ disease, systemic lupus erythematosus, Lyme disease, Sjögren's syndrome, primary biliary cirrhosis, and cholestatic liver disease
  • Longstanding (chronic) appendicitis
  • Insect and spider bites
  • Hormonal factors such as thyroid over-activity and menstruation

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Erythema Annulare Centrifugum? (Etiology)

The exact cause of development of Erythema Annulare Centrifugum (EAC) is unknown (idiopathic) in a majority.

  • Some say it may be an allergic condition (hypersensitivity reaction) or caused by infection. While other researchers believe that it may be caused by stress
  • Several factors and underlying conditions have been associated with EAC including certain food types, medications, infections, skin disorders, hormonal conditions, and malignancies

But, it is important to note that Erythema Annulare Centrifugum is non-contagious and, it cannot be transmitted from one individual to another.

What are the Signs and Symptoms of Erythema Annulare Centrifugum?

The signs and symptoms of Erythema Annulare Centrifugum (EAC) include:

  • Skin lesions that are red and concentric in appearance. Often multiple skin rashes are noted
  • They may range from 0.5 to 10 cm in size; the rings may grow about 2 to 5 mm per day
  • EAC usually involves the lower limbs; but, the upper limbs can also be affected
  • In rare cases, it may be present on the face and trunk (chest and back)
  • The lesions typically occur on non-sun exposed areas
  • It is important to note that EAC may not always form as rings, they may be irregular in shape too
  • The lesions may itch leading to scratching and bleeding

How is Erythema Annulare Centrifugum Diagnosed?

A diagnosis of Erythema Annulare Centrifugum may involve the following:

  • A thorough medical history assessment and complete physical examination
  • Dermoscopy: It is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
  • Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
  • Blood test to diagnose underlying disorders, if any
  • Culture studies to rule out any infection
  • Imaging studies to diagnose underlying conditions, if any
  • Skin biopsy: A skin biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis
  • A differential diagnosis may be undertaken to rule out the following skin conditions that may present similar symptoms:
    • Bullous pemphigoid
    • Cutaneous larva migrans
    • Drug eruptions
    • Eczema
    • Erythema migrans
    • Erythema multiforme
    • Fungal infection
    • Lupus
    • Porokeratosis
    • Sarcoidosis
    • Sweet syndrome
    • Urticaria

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Erythema Annulare Centrifugum?

In many cases, Erythema Annulare Centrifugum is a benign condition, and it does not cause any significant complications. However, the following factors may be a cause for concern in some individuals:

  • The presence of large patches of skin lesions may result in cosmetic issues (especially when it involves the face or exposed skin areas)
  • This may result in emotional stress
  • Secondary bacterial and fungal infection due to scratching and bleeding
  • The lesions may last for a long duration; even about 12 months, on an average
  • Complications may arise from the underlying conditions, if any present

How is Erythema Annulare Centrifugum Treated?

Erythema Annulare Centrifugum (EAC) may require no treatment in many individuals. In such cases, monitoring the condition and following a ‘wait and watch’ approach may be undertaken. If the cause of EAC is known, then managing the underlying cause may result in a cure. In case of significant symptoms, such as cosmetic issues, the condition may be treated.

The following treatment may be beneficial for Erythema Annulare Centrifugum, although are not proven measures for the condition:

  • In some, corticosteroid therapy may be helpful
  • Undertaking treatment for stress
  • Treating underlying conditions and disorders, if any
  • Check workplace or living space for molds and fungi

Follow-up care with regular screening and check-ups are important and encouraged.

How can Erythema Annulare Centrifugum be Prevented?

Currently, there are no known methods to prevent the occurrence of Erythema Annulare Centrifugum. However, one may lower the risk for the skin condition by considering the following factors:

  • Stress management
  • Treat any underlying infections/conditions early and adequately
  • Inform your physician if you are allergic to certain drugs

What is the Prognosis of Erythema Annulare Centrifugum? (Outcomes/Resolutions)

The prognosis for Erythema Annulare Centrifugum is usually good, in many cases. However, the prognosis is also dependent on the underlying cause and the severity of the symptoms presented.

  • It is a self-limiting condition in many individuals
  • Treating the underlying cause, if known, can result in a cure
  • However, in some individuals, the skin lesions may persist for a long period that may range from months to years

Additional and Relevant Useful Information for Erythema Annulare Centrifugum:

  • Do not pick or pop the blisters, for doing so can affect the healing process and may result in secondary infections
  • Cleaning the skin too hard with strong chemicals or soaps may aggravate the skin condition. Care must be taken avoid strong soaps and chemicals that could potentially worsen the condition
  • The presence of dirt on the body is not a causative factor for the condition. However, it helps to be clean and hygienic, which may help the condition from getting worse

What are some Useful Resources for Additional Information?

References and Information Sources used for the Article:

Helpful Peer-Reviewed Medical Articles:

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: June 24, 2018
Last updated: April 17, 2021